RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXX	CASE:  PD-2015-01815
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20040215

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Cannon Crewmember, medically separated for “pes planus, bilateral,” with a disability rating of 10%.

CI CONTENTION:  The CI contends for his unfitting bilateral feet, his medically acceptable low back pain and migraines, and conditions not identified by either the MEB or PEB.  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The panel’s assessment of the PEB rating determination is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition(s) at the time of separation.  The panel has neither the role nor the authority to compensate for progression or complications of service-connected conditions after separation.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20031121	VARD - NA	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Pes Planus, Bilateral 	5299-5276	10%	No VA Examination In Evidence	
Intermittent Low Back Pain with Radicular Symptoms 	Medically Acceptable		
Migraine Headache			
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  NA	

ANALYSIS SUMMARY:  

Pes Planus, Bilateral.  According to the service treatment record (STR) and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI suffered an atraumatic onset of bilateral foot pain in June 2001, and was diagnosed by podiatry with “acquired pes planus” complicated by chronic plantar fasciitis.  No surgery was indicated and he did not respond adequately to a trial of orthotics and conservative measures.  There was documentation in STR clinical entries of normal range of motion (ROM) and the absence of swelling or deformity.  There were no entries that indicated gait disturbance or serious functional impairment; and, there was no documentation of any additional VASRD-ratable findings or alternate diagnosis coded in the VASRD. 

The 25 September 2003 NARSUM examination, 5 months prior to separation, documented bilateral foot pain rated “slight and frequent” that prohibited running, marching, and load bearing.  The physical examination recorded “bilateral plantar tenderness and moderate to severe pronation on the foot examination.”  There was no documentation of swelling, callosities, painful motion or other findings.  The examiner forwarded the diagnosis “acquired pes planus” on the MEB’s DD Form 3947 submission.  There was no evidence probative to separate fitness considerations for either foot in the NARSUM, the commander’s performance statement, or the profile.  There was no VA Compensation and Pension examination in evidence proximate to separation.

The panel directed attention to its rating recommendation based on the above evidence.  The PEB’s bilateral 10% rating under code 5299-5276 (analogous to acquired pes planus) cited the “moderate” criterion of code 5276 commensurate with that rating.  The criteria for the next higher 30% bilateral rating under 5276 are “severe; objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities.”  Members agreed that the evidence from the STR and NARSUM did not adequately support any of these criteria, and specifically refuted most of them. 

The panel considered separate rating of each foot under code 5310, the muscle disability code for Group X (movements of forefoot and toes), which is sometimes deployed for analogous rating of plantar fasciitis.  It was agreed, however, that separate ratings were not adequately justified under 5310 or any alternate code.  Firstly, there was insufficient evidence for concluding that each foot was reasonably justified as separately unfitting as requisite for service rating; and, secondly, code 5276 is very specific for the primary and specialty-confirmed diagnosis in this case.  Members thus agreed that it was not justified to leverage an alternate code in pursuit of a higher rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel concluded that there was insufficient cause to recommend a change in the PEB adjudication of bilateral pes planus.
 
Contended PEB Conditions:  Intermittent Low Back Pain with Radicular Symptoms and Migraine Headache. The panel’s main charge was to assess the fairness of the PEB’s determinations that the above conditions were not unfitting.  Members agreed that there was no performance-based evidence indicating that either of the above conditions interfered with duty requirements to an extent that would have prohibited further military service.  After due deliberation in consideration of the preponderance of the evidence, the panel concluded that there was insufficient cause to recommend a change in the PEB fitness determinations for the lumbar and headache conditions; thus, neither were eligible for a rating.

BOARD FINDINGS:  In the matter of the pes planus, bilateral condition and IAW VASRD §4.71a, the panel unanimously recommends no change in the PEB adjudication.  In the matter of the contended intermittent low back pain with radicular symptoms and migraine headache conditions, the panel unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the panel’s scope of review for consideration.  The panel, therefore, recommends that there be no modification or re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20150624, w/attachments
Exhibit B.  Service Treatment Record

AR20170009332, XXXXXXXXXXXXXXXXXX

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Dear XXXXXXXXXXXXXXXXXX:

	The Department of Defense Physical Disability Board of Review (DoD PDBR) reviewed your application and found your separation disability rating and your separation from the Army for disability with severance pay to be accurate.  I have reviewed the Board’s recommendation and record of proceedings (copy enclosed), and I accept its recommendation.  I regret to inform you that your application to the DoD PDBR is denied.  

	This decision is final.  Recourse within the Department of Defense or the Department of the Army is exhausted; however, you have the option to seek relief by filing suit in a court of appropriate jurisdiction.

Sincerely,					       
						      					
Enclosure